Surgical instrument

ABSTRACT

A surgical instrument that includes an instrument shaft having proximal and distal ends, a tool disposed from the distal end of the instrument shaft, a control handle disposed from the proximal end of the instrument shaft, a distal motion member for coupling the distal end of the instrument shaft to the tool, a proximal motion member for coupling the proximal end of the instrument shaft to the handle, actuation means extending between the distal and proximal motion members for coupling motion of the proximal motion member to the distal motion member for controlling the positioning of the tool and a locking mechanism for fixing the position of the tool at a selected position and having locked and unlocked states.

RELATED APPLICATION

Priority for this application is hereby claimed under 35 U.S.C. §119(e)to commonly owned and co-pending U.S. Provisional Patent Application No.60/844,130 which was filed on Sep. 13, 2006. The content of all of theaforementioned application is hereby incorporated by reference herein inits entirety.

TECHNICAL FIELD

The present invention relates in general to medical instruments, andmore particularly to manually-operated surgical instruments that areintended for use in minimally invasive surgery or other forms ofsurgical or medical procedures or techniques. The instrument describedherein is primarily for a laparoscopic procedure, however, it is to beunderstood that the instrument of the present invention can be used fora wide variety of other procedures, including intraluminal procedures.

BACKGROUND OF THE INVENTION

Endoscopic and laparoscopic instruments currently available in themarket are extremely difficult to learn to operate and use, mainly dueto a lack of dexterity in their use. For instance, when using a typicallaparoscopic instrument during surgery, the orientation of the tool ofthe instrument is solely dictated by the location of the target and theincision. These instruments generally function with a fulcrum effectusing the patients own incision area as the fulcrum. As a result, commontasks such as suturing, knotting and fine dissection have becomechallenging to master. Various laparoscopic instruments have beendeveloped over the years to overcome this deficiency, usually byproviding an extra articulation often controlled by a separatelydisposed control member for added control. However, even so theseinstruments still do not provide enough dexterity to allow the surgeonto perform common tasks such as suturing, particularly at anyarbitrarily selected orientation. Also, existing instruments of thistype do not provide an effective way to hold the instrument in aparticular position. Moreover, existing instruments require the use ofboth hands in order to effectively control the instrument.

Accordingly, an object of the present invention is to provide animproved laparoscopic or endoscopic surgical instrument that allows thesurgeon to manipulate the tool end of the surgical instrument withgreater dexterity.

Another object of the present invention is to provide an improvedsurgical or medical instrument that has a wide variety of applications,through incisions, through natural body orifices or intraluminally.

A further object of the present invention is to provide an improvedmedical instrument that is characterized by the ability to lock theinstrument in a pre-selected particular position.

Another object of the present invention is to provide a locking featurethat is an important adjunct to the other controls of the instrumentenabling the surgeon to lock the instrument once in the desiredposition. This makes it easier for the surgeon to thereafter performsurgical procedures without having to, at the same time, hold theinstrument in a particular bent configuration. Still another object ofthe present invention is to provide an improved medical instrument thatcan be effectively controlled with a single hand of the user.

SUMMARY OF THE INVENTION

To accomplish the foregoing and other objects, features and advantagesof the present invention there is provided a surgical instrument thatcomprises an instrument shaft having proximal and distal ends; a tooldisposed from the distal end of the instrument shaft; a control handlecoupled from the proximal end of the instrument shaft; a distal motionmember for coupling the distal end of the instrument shaft to the tool;a proximal motion member for coupling the proximal end of the instrumentshaft to the handle; actuation means extending between the distal andproximal motion members for coupling motion of the proximal motionmember to the distal motion member for controlling the positioning ofthe tool; and a locking mechanism for fixing the position of the tool ata selected position and having locked and unlocked states with thelocking mechanism including a ball and socket arrangement disposed aboutthe proximal motion member and a cinch member for locking the ball andsocket arrangement.

In accordance with other aspects of the present invention the surgicalinstrument may further include a rotation means disposed adjacent thecontrol handle and rotatable relative to the control handle for causinga corresponding rotation of the instrument shaft and tool; at least theproximal motion member may comprise a proximal bendable member, with therotation means comprising a rotation knob that is adapted to rotate thetool about a distal tool roll axis and being disposed between thecontrol handle and proximal bendable member; the control handle maycomprise a pistol grip handle having an engagement horn to assist inholding the handle; the rotation means may comprises a rotation knobthat is disposed at the distal end of the handle and the horn isdisposed proximally of the rotation knob and on the top of the pistolgrip handle; preferably including an actuation lever supported from thepistol grip handle at a pivot point at the proximal end of the handle;the actuation lever may have a free end with a finger loop for receivinga users finger to control the lever; preferably including a toolactuation cable that extends from the tool to the handle, a slider forcapturing the proximal end of the tool actuation cable and an actuationlever supported at the handle for controlling the translation of theslider; preferably including a slideway for receiving the slider, a pairof springs disposed in the slider and a rotational barrel disposedbetween the springs and for holding the proximal end of the toolactuation cable; the ball and socket arrangement may comprise a ballmember having a partially spherical portion that mates with a concavesocket in the handle; the handle may have a distal collar with thesocket formed on the inner surface of the collar and the cinch membermay include an annular cinch ring that is disposed about the distalcollar; preferably including a tongue and groove interconnection betweenthe cinch ring and collar so as to permit rotation therebetween whilepreventing axial movement; preferably including a pivot piece on thecinch ring having opposed locked and unlocked positions; and preferablythe distal collar has one or more slots to enable the socket to becompressed about the ball member as the cinch ring is locked.

In accordance with another feature of the present invention there isprovided a surgical instrument that comprises an instrument shaft havingproximal and distal ends; a tool disposed from the distal end of theinstrument shaft; a control handle disposed from the proximal end of theinstrument shaft; a distal motion member for coupling the distal end ofthe instrument shaft to the tool; a proximal motion member for couplingthe proximal end of the instrument shaft to the handle; actuation meansextending between the distal and proximal motion members for couplingmotion of the proximal motion member to the distal motion member forcontrolling the positioning of the tool; said control handle including apistol grip handle; an actuation lever for controlling the tool andpivotally supported from the handle; and an adjustment member mounted onthe lever for adjusting the attitude or angle of the actuation leverrelative to a center plane of the handle.

In accordance with still other aspects of the present invention there isprovided a surgical instrument wherein the adjustment member includes anadjustment lever for changing the attitude or angle between positive andnegative values; wherein the adjustment member includes a beveled washermeans; wherein the adjustment lever is supported from the same pivotalsupport as for the actuation lever; further including an engagement hornto assist in holding the handle and a rotation knob disposed at thedistal end of the handle and the horn is disposed proximally of therotation knob and on the top of the pistol grip handle.

In accordance with still another feature of the present invention thereis provided a medical instrument having a proximal control handle and adistal tool that are intercoupled by an elongated instrument shaft thatis meant to pass internally of an anatomic body, proximal and distalmovable members that respectively intercouple the proximal controlhandle and the distal tool with the instrument shaft, cable actuationmeans disposed between the movable members, the control handle havingproximal and distal ends, an actuation lever for controlling the distaltool, means for pivotally supporting the actuation lever from theproximal end of the handle at one side thereof, a horn and means forfixedly supporting the horn from the distal end of the handle at anopposite side thereof.

In accordance with other aspects of the present invention there isprovided a medical instrument wherein the cable actuation means includesa set of actuation cables that are sufficiently rigid so that each cableis capable of either a pulling or pushing action in controlling thetool; including constraining means for each cable so as to substantiallyrestrain each cable as it extends between the proximal and distalmovable members; wherein the control handle includes a pistol griphandle and the actuation lever includes an adjustment member mounted onthe lever for adjusting the attitude or angle of the actuation leverrelative to a center plane of the handle.

In accordance with a further feature of the present invention there isprovided a medical instrument having a proximal control handle and adistal tool that are intercoupled by an elongated instrument shaft thatis meant to pass internally of an anatomic body, proximal and distalmovable members that respectively intercouple the proximal controlhandle and the distal tool with the instrument shaft, cable actuationmeans disposed between the movable members, for controlling thepositioning of the distal tool, and means for constraining the cablemeans along its length so as to enable both a pulling action and apushing action thereof.

In accordance with further aspects of the present invention there isprovided a medical instrument wherein the cable means are constrainedalong substantially the entire length thereof; and wherein theconstraining means includes a shaft filler disposed in the instrumentshaft about the cable means.

In accordance with still another feature of the present invention thereis provided a medical instrument having a proximal control handle and adistal tool that are intercoupled by an elongated instrument shaft thatis meant to pass internally of an anatomic body, proximal and distalmovable members that respectively intercouple the proximal controlhandle and the distal tool with the instrument shaft, cable actuationmeans disposed between the movable members, for controlling thepositioning of the distal tool, and a locking mechanism having lockedand unlocked positions, disposed about the proximal movable member andmanually controlled so as to fix the position of the proximal movablemember relative to the handle in the locked position thereof.

In accordance with other aspects of the present invention there isprovided a medical instrument wherein the locking mechanism comprises aball member and a compressible hub that defines a socket member; whereinthe hub is a split hub and the locking mechanism further includes acinch ring disposed about the split hub and a locking lever mounted onthe cinch ring for closing the cinch ring about the hub to lock the hubagainst the ball member; wherein the cinch ring interlocks with the hubbut is able to rotate relative thereto when in the unlocked position;and including a rotation control member adjacent to the proximal movablemember for controlling the orientation of the distal movable member andtool.

BRIEF DESCRIPTION OF THE DRAWINGS

It should be understood that the drawings are provided for the purposeof illustration only and are not intended to define the limits of thedisclosure. The foregoing and other objects and advantages of theembodiments described herein will become apparent with reference to thefollowing detailed description when taken in conjunction with theaccompanying drawings in which:

FIG. 1 is a perspective view of a preferred embodiment of the instrumentof the present invention illustrating the instrument being grasped by auser and further schematically illustrating the instrument disposed atan operative site;

FIG. 2 is a cross-sectional side view of the instrument of FIG. 1 byitself and with the cross- sectional view primarily illustrating theproximal or handle end of the instrument;

FIG. 3 is an enlarged cross-sectional side view showing the instrumentof FIG. 2 in an angled relationship and with the jaws closed on aneedle;

FIGS. 4A-4C are illustrative cross-sectional side views at the distalend of the medical instrument, and with the movable jaw in differentrespective positions;

FIG. 4D is a radial cross-sectional view taken along line 4D-4D of FIG.4C;

FIG. 5 is a cross-sectional front view of the instrument of FIG. 1 astaken along line 5-5 of FIG. 2 and showing the locking lever in itslocked position;

FIG. 6 is a cross-sectional front view of the instrument illustrated inFIG. 5 showing the locking lever in its unlocked position, and furtherillustrating some components of the instrument broken away to illustratecertain adjustments that can be made to accommodate the user of theinstrument;

FIG. 7 is a cross-sectional plan view taken along line 7-7 of FIG. 2;

FIG. 8 is a fragmentary cross-sectional view taken along line 8-8 ofFIG. 5 but showing the instrument in an angled relationship;

FIG. 9 is an enlarged cross-sectional view at the instrument shaft takenalong line 9-9 of FIG. 8;

FIG. 10 is a cross-sectional view at the adapter of the instrument astaken along line 10-10 of FIG. 8;

FIG. 11 is a cross-sectional view at the rotation knob of the instrumentas taken along line 11-11 of FIG. 7;

FIGS. 12-14 are somewhat schematic enlarged fragmentary cross-sectionalviews of the handle basically taken along line 12-12 of FIG. 7 showingthe operation of the jaw clamping lever means for different positionsthereof; and

FIG. 15 is a schematic perspective view of the instrument illustratedherein.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The instrument of the present invention may be used to perform minimallyinvasive procedures. “Minimally invasive procedure,” refers herein to asurgical procedure in which a surgeon operates through a small cut orincision, the small incision being used to access the operative site. Inone embodiment, the incision length ranges from 1 mm to 20 mm indiameter, preferably from 5 mm to 10 mm in diameter. This procedurecontrasts those procedures requiring a large cut to access the operativesite. Thus, the flexible instrument is preferably used for insertionthrough such small incisions and/or through a natural body lumen orcavity, so as to locate the instrument at an internal target site for aparticular surgical or medical procedure. The introduction of thesurgical instrument into the anatomy may also be by percutaneous orsurgical access to a lumen, vessel or cavity, or by introduction througha natural orifice in the anatomy.

In addition to use in a laparoscopic procedure, the instrument of thepresent invention may be used in a variety of other medical or surgicalprocedures including, but not limited to, colonoscopic, upper GI,arthroscopic, sinus, thorasic, prostate, transvaginal, orthopedic andcardiac procedures. Depending upon the particular procedure, theinstrument shaft may be rigid, semi-rigid or flexible.

Although reference is made herein to a “surgical instrument,” it iscontemplated that the principles of this invention also apply to othermedical instruments, not necessarily for surgery, and including, but notlimited to, such other implements as catheters, as well as diagnosticand therapeutic instruments and implements.

There are a number of unique features embodied in the instrument of thepresent invention. For example, there is provided a locking mechanismthat is constructed using a ball and socket arrangement disposed aboutthe proximal motion member that follows the bending action and in whichan annular cinch ring is used to retain the ball and socket arrangementin a fixed particular position, and thus also maintain the proximal anddistal bendable members in a particular bent condition, or in otherwords locked in that position. The cinch ring includes a locking leverthat is conveniently located adjacent to the instrument handle and thatis easily manipulated to lock and unlock the cinch ring and, in turn,the position of the end effector. The cinch ring is also preferablyrotatable to that the locking lever can be positioned conveniently orcan be switched (rotated) between left and right handed users. This lockcontrol allows the surgeon one less degree of freedom to concentrate onwhen performing certain tasks. By locking the bendable sections at aparticular position, this enables the surgeon to be more hands-free forcontrolling other degrees of freedom of the instrument such asmanipulation of the rotation knob to, in turn, control the orientationof the end effector.

Another feature of the present invention relates to the manner in whichthe bending is carried out. In the past, relatively small diameterflexible cables have been used to control bending between the proximaland distal bendable members. However, this has caused a somewhat unevencontrol in that there was only a “pulling” action by one cable while theopposite cable relaxed. The present invention uses a more rigid cablearrangement so that the bending occurs with both a “pulling” action aswell as an opposed “pushing” action. To do this the cables are of largerrelative diameter and somewhat rigid, but still have to have sufficientflexibility so that they can readily bend. Also, the cables areconstrained along their length so as to prevent cable deflection orbuckling, particularly during the “pushing” phase of a cable.

Still another feature is the pistol grip arrangement and the controllever which has an end gimbal construction that provides for a moreprecise control of the actuation lever and the corresponding actuationof the end effector. Also the control lever in accordance with thepresent invention is provided with a means to control the attitude ofthe control lever to compensate for different configurations of hands,particularly to compensate for the different length fingers of a user.

FIG. 1 is a perspective view of one embodiment of the surgicalinstrument 10 of the present invention. In this surgical instrument boththe tool and handle motion members or bendable members are capable ofbending in any direction. They are interconnected via cables (preferablyfour cables) in such a way that a bending action at the proximal memberprovides a related bending at the distal member. The proximal bending iscontrolled by a motion or deflection of the control handle by a user ofthe instrument. In other words the surgeon grasps the handle and oncethe instrument is in position any motion (deflection) at the handleimmediately controls the proximal bendable member which, in turn, viacabling controls a corresponding bending or deflection at the distalbendable member. This action, in turn, controls the positioning of thedistal tool.

The proximal member is preferably generally larger than the distalmember so as to provide enhanced ergonomic control. In the illustratedembodiment the ratio of proximal to distal bendable member diameters maybe on the order of three to one. In one version in accordance with theinvention there may be provided a bending action in which the distalbendable member bends in the same direction as the proximal bendablemember. In an alternate embodiment the bendable, turnable or flexiblemembers may be arranged to bend in opposite directions by rotating theactuation cables through 180 degrees, or could be controlled to bend invirtually any other direction depending upon the relationship betweenthe distal and proximal support points for the cables.

As has been noted the, amount of bending motion produced at the distalbending member is determined by the dimension of the proximal bendablemember in comparison to that of the distal bendable member. In theembodiment described the proximal bendable member is generally largerthan the distal bendable member, and as a result, the magnitude of themotion produced at the distal bendable member is greater than themagnitude of the motion at the proximal bendable member. The proximalbendable member can be bent in any direction (about 360 degrees)controlling the distal bendable member to bend in either the same or anopposite direction, but in the same plane at the same time. Also, asdepicted in FIG. 1, the surgeon is able to bend and roll theinstrument's tool about its longitudinal axis T to any orientationsimply by rolling the axial rotation knob about rotation direction R1.

In this description reference is made to bendable members. These membersmay also be referred to as turnable members, bendable sections orflexible members. In the descriptions set out herein, terms such as“bendable section,” “bendable segment,” “bendable member,” or “turnablemember” refer to an element of the instrument that is controllablybendable in comparison to an element that is pivoted at a joint. Theterm “movable member” is considered as generic to bendable sections andjoints. The bendable elements of the present invention enable thefabrication of an instrument that can bend in any direction without anysingularity and that is further characterized by a ready capability tobend in any direction, all preferably with a single unitary or uni-bodystructure. A definition of a “unitary” or “uni-body” structure is ---- astructure that is constructed only of a single integral member and notone that is formed of multiple assembled or mated components----.

A definition of these bendable members is --an instrument element,formed either as a controlling means or a controlled means, and that iscapable of being constrained by tension or compression forces to deviatefrom a straight line to a curved configuration without any sharp breaksor angularity--. Bendable members may be in the form of unitarystructures, such as shown herein in FIGS. 1 and 2, may be constructed ofengageable discs, or the like, may include bellows arrangements or maycomprise a movable ring assembly. For other forms of bendable membersrefer to co-pending applications Ser. Nos. 11/505,003 filed on Aug. 16,2006 and 11/523,103 filed on Sep. 19, 2006, both of which are herebyincorporated by reference herein in their entirety.

FIG. 1 shows a preferred embodiment of the instrument of the presentinvention. Further details are illustrated in FIGS. 2 through 15. FIG. 1depicts the surgical instrument 10 in position, as may occur during asurgical procedure. For example, the instrument may be used forlaparoscopic surgery through the abdominal wall, such as shown at 4 inFIG. 1. For this purpose there is provided an insertion site at whichthere is disposed a cannula or trocar 6. The shaft 14 of the instrument10 is adapted to pass through the cannula or trocar 6 so as to disposethe distal end of the instrument at the operative site. The end effector16 is depicted in FIG. 1 at such an operative site with the cannula ortrocar 6 at the incision point in the skin 4. The embodiment of theinstrument shown in FIG. 1 is typically used with a sheath 98 to keepbodily fluids from entering the distal bending member 20.

A rolling motion can be carried out with the instrument of the presentinvention. This can occur by virtue of the rotation of the rotation knob24 relative to the handle 12 about axis T (refer to FIG. 3). This isrepresented in FIG. 1 by the rotation arrow R1. When the rotation knob24 is rotated, in either direction, this causes a corresponding rotationof the instrument shaft 14. This is depicted in FIG. 1 by the rotationalarrow R2. This same motion also causes a rotation of the distal bendablemember and end effector 16 about an axis that corresponds to theinstrument tip, depicted in FIGS. 1 and 3 as about the longitudinal tipor tool axis P.

Any rotation of the rotation knob 24 while the instrument is locked (orunlocked) maintains the instrument tip at the same angular position, butrotates the orientation of the tip (tool). For a further explanation ofthe tip rotational feature refer to co-pending application Ser. No.11/302,654, filed on Dec. 14, 2005, particularly FIGS. 25-28, which ishereby incorporated by reference in its entirety.

The handle 12, via proximal bendable member 18, may be tilted at anangle to the instrument shaft longitudinal center axis. This tilting,deflecting or bending may be considered as in the plane of the paper. Bymeans of the cabling this action causes a corresponding bend at thedistal bendable member 20 to a position wherein the tip is directedalong an axis and at a corresponding angle to the instrument shaftlongitudinal center axis. The bending at the proximal bendable member 18is controlled by the surgeon from the handle 12 by manipulating thehandle in essentially any direction including in and out of the plane ofthe paper in FIG. 1. This manipulation directly controls the bending atthe proximal bendable member. Refer to FIG. 3 in which there is shownthe axis U corresponding to the instrument shaft longitudinal axis.Refer also to the proximal bend angle B1 between axes T and U, and thecorresponding distal bend angle B2 between axes U and P.

Thus, the control at the handle is used to bend the instrument at theproximal motion member to, in turn, control the positioning of thedistal motion member and tool. The “position” of the tool is determinedprimarily by this bending or motion action and may be considered as thecoordinate location at the distal end of the distal motion member.Actually, one may consider a coordinate axis at both the proximal anddistal motion members as well as at the instrument tip. This positioningis in three dimensions. Of course, the instrument positioning is alsocontrolled to a certain degree by the ability of the surgeon to pivotthe instrument at the incision point (cannula 6). The “orientation” ofthe tool, on the other hand, relates to the rotational positioning ofthe tool, from the proximal rotation control member, about theillustrated distal tip or tool axis P.

In the drawings a set of jaws is depicted, however, other tools ordevices may be readily adapted for use with the instrument of thepresent invention. These include, but are not limited to, cameras,detectors, optics, scope, fluid delivery devices, syringes, etc. Thetool may include a variety of articulated tools such as: jaws, scissors,graspers, needle holders, micro dissectors, staple appliers, tackers,suction irrigation tools and clip appliers. In addition, the tool mayinclude a non-articulated tool such as: a cutting blade, probe,irrigator, catheter or suction orifice.

The surgical instrument of FIG. 1 shows a preferred embodiment of asurgical instrument 10 according to the invention in use and may beinserted through a cannula at an insertion site through a patient'sskin. Many of the components shown herein, such as the instrument shaft14, end effector 16, distal bending member 20, and proximal bendingmember 18 may be similar to and interact in the same manner as theinstrument components described in the co-pending U.S. application Ser.No. 11/185,911 filed on Jul. 20, 2005 and hereby incorporated byreference herein in its entirety. Many other components shown herein,particularly at the handle end of the instrument may be similar tocomponents described in the co-pending U.S. application Ser. No.11/528,134 filed on Sep. 27, 2006 and hereby incorporated by referenceherein in its entirety. Also incorporated by reference in their entiretyare U.S. application Ser. No. 10/822,081 filed on Apr. 12, 2004; U.S.application Ser. No. 11/242,642 filed on Oct. 3, 2005 and U.S.application Ser. No. 11/302,654 filed on Dec. 14, 2005, all commonlyowned by the present assignee.

As illustrated in FIGS. 3-8, the control between the proximal bendablemember 18 and distal bendable member 20 is provided by means of the bendcontrol cables 100. In the illustrated embodiment four such controlcables 100 are provided in order to provide the desired all directionbending. However, in other embodiments of the present invention fewer orless numbers of bend control cables may be used. The bend control cables100 extend through the instrument shaft 14 and through the proximal anddistal bendable members such as shown in FIGS. 3 and 4. The bend controlcables 100 are constrained along substantially their entire length so asto facilitate both “pushing” and “pulling” action in accordance with oneaspect of the present invention as discussed in further detailhereinafter. The cables 100 are also constrained as they pass over theconical cable guide portion 19 of the proximal bendable member, andthrough the proximal bendable member. Refer, for example, to FIGS. 7 and8.

The locking means of the present invention interacts with the novel balland socket arrangement to lock and unlock the positioning of the cableswhich in turn control the angle of the proximal bending member and thusthe angle of the distal bendable member and end effector. This lockcontrol allows the surgeon one less degree of freedom to concentrate onwhen performing certain tasks. By locking the bendable sections at aparticular position, this enables the surgeon to be more hands-free forcontrolling other degrees of freedom of the instrument such asmanipulation of the rotation knob 24 and, in turn, orientation of theend effector.

The instrument shown in FIG. 1 is of a pistol grip type. However, theprinciples of the present invention may also apply to other forms ofhandles such as a straight in-line handle. In FIG. 3 there is shown ajaw clamping means 30 that is comprised mainly of the lever 22 which hasa single finger hole for controlling the lever and also includes arelated release function controlled directly by the lever 22 rather thana separate release button. The release function is used to release theactuated or closed tool, and is discussed in further detail hereinafter.

In the instrument that is illustrated the handle end of the instrumentmay be tipped in any direction as the proximal bendable member isconstructed and arranged to enable full 360 degree bending. Thismovement of the handle relative to the instrument shaft bends theinstrument at the proximal bendable member 18. This action, in turn, viathe bend control cables 100, bends the distal bendable member in thesame direction. As mentioned before, opposite direction bending can beused by rotating or twisting the control cables through 180 degrees fromone end to the other end thereof. Refer to the schematic perspectiveview of FIG. 15 for an illustration of the straight cabling used in theillustrated instrument.

In the embodiment described herein, the handle 12 is in the form of apistol grip and includes a horn 13 to facilitate a comfortable interfacebetween the action of the surgeon's hand and the instrument. The toolactuation lever 22 is shown in FIGS. 1-3 pivotally attached at the baseof the handle. The lever 22 actuates a slider 28 that controls a toolactuation cable 38 that extends from the slider to the distal end of theinstrument. The cable 38 controls the opening and closing of the jaws,and different positions of the lever control the force applied at thejaws.

The shape of the handle allows for a comfortable and substantiallyone-handed operation of the instrument as shown in FIG. 1. As shown inFIG. 1, the surgeon may grip the handle 12 between his palm and middlefinger with the horn 13 nestled in the crook between his thumb andforefinger.

This frees up and positions the forefinger and thumb to rotate therotation knob 24 using the finger indentions 31 that are disposed on theperipheral surface of the rotation knob, as depicted in FIG. 11. In bothlocked and unlocked positions of the instrument the rotation knob iscapable of controlled rotation to control axial rotation at the tip ofthe instrument about the distal tool tip axis P, as represented by therotation arrow R3 in FIG. 1.

In the disclosed embodiment there is provided at the tool closing lever22 a fingertip engaging recess 23 in a gimbaled ball 27. The free end ofthe lever 22 supports the gimbaled ball 27 which has a through hole orrecess 23 which receives one of the fingers of the user. The ball 27 isfree to at least partially rotate in three dimensions in the lever end.The surgeon may grip the handle between the palm, ring and pinky fingerswith the horn 13 nestled in the crook between his thumb and forefingerand operate the rotation knob 24 as previously described. The surgeonmay then operate the jaw clamping lever 22 with the forefinger or middlefinger.

The gimbal is in the form of a ball in a socket, in which the ball 27 isfree to be rotated in the socket, and in which the socket is defined inthe lever free end. In this embodiment, rather than having the hole orrecess 23 go completely through the ball there is preferably provided ablind hole in the ball. This blind hole is shown in FIGS. 5 and 6. Theball is free to rotate in the lever end and thus the ball can also berotated to alternate positions corresponding to either a right-handed(FIG. 5) or left-handed (FIG. 6) user. The blind hole (in comparison toa through hole) enables the user to have a firmer grip of the lever andthus enhanced control of the lever action.

Reference is now made to FIGS. 2-4. In this instrument the distalbendable member 20 is shown without any protective sheath so as to showsome of the details of the distal bendable member 20. The distalbendable member is comprised of spaced discs 110 that definetherebetween spaced slots 112. Ribs 111 may connect between adjacentdiscs in a manner similar to that described in the afore-mentioned U.S.application Ser. No. 11/185,911.

Refer also now to FIGS. 4A-4D for further details of the tool end of theinstrument. FIG. 4A depicts the jaws in a fully open position. FIG. 4Bdepicts the jaws grasping a needle. FIG. 4C depicts the jaws fullyclosed. FIG. 4D is a cross-sectional view taken along line 4D-4D of FIG.4C. The end effector 16 is comprised of a pair of jaws 44 and 46. Thejaws 44 and 46 may be used to grasp a needle 45 or other item as shownin FIG. 3. The upper jaw 44 fits within a channel 47 in the lower jaw46. A pivot pin 48 is used between the jaws to enable rotationtherebetween. A translation pin 42 extends through the slot 50 of jaw 46and the slot 52 of jaw 44 and engages with the hole in the distal cableend connector 40. The connector 40 is secured to the very distal end ofthe jaw actuator cable 38 and is positioned within a channel of the jaw44. When the lever 22 is in its rest position, as depicted in FIG. 2,the jaws are fully open. In that position the pin 42 is at a more distallocation maintaining the jaws in an open position. As the cable 38 ispulled, such as proximally in FIG. 3, then the pin 42 moves to the rightin the slots 50 and 52 causing the jaws 44 and 46 to pivot toward aclosed position.

FIGS. 4A-4D also depicts an end wall or plate 54 of the jaw 46. One endof the distal bendable member 20 is urged against this end wall 54. Themember 20 may be secured to the wall 54 by an appropriate means. In oneembodiment, the cabling tension itself of the instrument holds themembers together. On the end wall 54 there are disposed a pair ofanchors 56 and 58 for the flex control cables 100. FIG. 4D illustratesfour such cables 100. The distal end of the distal bendable member 20may be provided with pockets for receiving the anchors 56 and 58. Theanchors 56 and 58 are firmly attached to the end wall 54. Refer also toFIG. 15 for an illustration of the cabling and the connections thereofat opposite ends of each cable 100.

The rotation knob 24 is provided with a proximal hub 25 which supportsthe proximal end of the proximal bending member 18. During assembly, thecables 100 which protrude from the proximal end of the proximal bendingmember 18, after the assembly of the end effector 16, inner and outershafts 32, 34, adapter 26 and proximal bending member 18, are passedthrough the four terminal wire crimps or lugs 102 which are keyed intopassages in the hub 25. The cables are tensioned and crimped and excesscable material is trimmed off. This arrangement holds all the elementstogether between the end effector 16 and the rotation knob hub 25 and,in turn, the rotation knob 24.

As indicated previously, the rotation knob 24 is formed with a hub 25 onits proximal side that is supported on the center wire conduit 64 whichextends from the rotation knob 24 back to the slider 28. An e-ring 65retains the hub 25 in a rotational relationship relative to the conduit64. The conduit 64 is supported in a fixed position by internal means ofthe handle 12. The knob 24 is readily accessible through a gap 232between the split hub 202 and the distal end of the handle. See the gap232 in FIG. 7. The rotation knob 24 has four keyhole shaped slots 103(FIG. 11) that mate with terminal wire crimps 102A-102D that enables a“push-pull” effect on the cables 100 when the handle is bent in relationto the shaft in contrast to past versions where the cables were in aspring-loaded “pull” relationship relative to the rotation knob. Becauseof this “push-pull” action, biasing springs associated with each cableare not used.

As indicated previously, the end effector or tool 16 is actuated bymeans of a jaw actuation mechanism or jaw clamping means 30 which iscomprised primarily of the elongated lever 22. The lever 22 is supportedfrom the housing at the lever pivot pin 72. Refer to FIGS. 2 and 3. Theclosing of the lever 22 against the handle 12 acts upon the slider 28which is used to capture the very proximal end of the actuation cable38. When the slider 28 is in the position depicted in FIG. 2, it isnoted that the end effector jaws are fully open. In that position theslider 28 is disposed at the more distal end of the slideway 84. Theslideway 84 is part of the internal support in the handle 12. When theslider 28 is moved proximally, as depicted in FIG. 3, then the jaws aremoved toward a closed position grasping the needle 45.

The instrument shaft 14 includes an outer shaft tube 32 that may beconstructed of a light weight metal material or may be a plasticmaterial. See the cross-sectional view of FIG. 9 taken through theinstrument shaft. The proximal end of the tube 32 is received by theadaptor 26, as depicted in FIGS. 7 and 8. The distal end of the tube 32is secured to the distal bendable member 20. Within the outer shaft tube32 there is provided a support tube 34 that is preferably constructed ofa plastic material. Tube 34 extends between the distal bendable orflexible member 20 and the proximal bendable or flexible member 18. Thejaw actuator cable 38 extends within this support tube 34.

One of the features of the present invention is the cable scheme thatuses bend control cables that are relatively stiff and yet are bendable.The stiffer cables allow for, not only “pulling”, but also “pushing”action thereof. This enables enhanced control via the cabling as controlis provided, not only when a cable is “pulled”, but also when a cable is“pushed”. This makes for a more uniform control via the cables. Toenable, not only a “pulling” action, but also a “pushing” action, thecables 100 are supported in relatively narrow lumens or passageways toprevent buckling when being pushed. This is facilitated by, inter alia,the provision of a shaft filler 36. To allow for the “pushing” action inparticular the cables are confined so that they do not distort withinthe instrument itself

The shaft filler 36 is disposed between the tubes 32 and 34 and is usedto hold the cables in place within the instrument shaft itself. As canbe seen in FIG. 9, the shaft filler has a central lumen 36A for theinner shaft support tube 34 and four lengthwise grooves 36B thataccommodate and allow a snug sliding fit for the cables 100. The conicalportion 19 of the proximal bending member 18 has four cable guidegrooves 106 disposed at 90 degree intervals about its outer surface thatcapture each cable in a sliding relationship with the adapter 26. Eachof the guide grooves is formed in a separate diametrically disposed wing108 of the conical portion 19. The adaptor 26 may also be provided withaccommodating grooves for the cables 100. Refer also to thecross-sectional view of FIG. 10 for an illustration of the cable guideand constraining arrangement. Thus, the cables are constrained alongtheir length in grooves or passages. Each of the cables is preferablyunsupported for only a short distance such as the distance of the slots132 shown in FIGS. 2 and 3, or like slots at the distal bendable member.

The jaw actuator cable 38 terminates at its respective ends at the endeffector (connector 40) and the rotation barrel 66 (see FIG. 3). Withineach of the bendable sections or bendable members 18 and 20 there isprovided a plastic tube. This includes a distal tube 60 and a proximaltube 62. Both of these tubes may be constructed of a plastic such aspolyethyletherkeytone (PEEK). The material of the tubes is sufficientlyrigid to retain the cable 38 and yet is flexible enough so that it canreadily bend with the bending of the bendable members 18 and 20. Thetubes have a sufficient strength to receive and guide the cable, yet areflexible enough so that they will not kink or distort, and thus keep thecable in a proper state for activation, and also defines a fixed lengthfor the cable. The tubes are longitudinally stiff, but laterallyflexible.

The proximal bendable member 18, like the distal bendable member 20, mayalso be constructed as a unitary or uni-body slotted structure includinga series of flexible discs 130 that define therebetween slots 132, asshown in FIG. 2. A “unitary” or “uni-body” structure may be defined asone that is constructed for use in a single piece and does not requireassembly of parts. Connecting ribs 131 are illustrated as extendingbetween adjacent discs 130. Both of the bendable members preferably havea rib pattern in which the ribs are disposed at a preferred 60 degreevariance from one rib to an adjacent rib. This has been found to providean improved bending action. It was found that by having the ribsdisposed at intervals of less than 90 degrees therebetween improvedbending was possible. The ribs may be disposed at intervals of fromabout 35 degrees to about 75 degrees from one rib to an adjacent one. Byusing an interval of less than 90 degrees the ribs are more evenlydistributed. As a result the bending motion is more uniform at anyorientation. In the present invention both of the bendable members maybe made of a highly elastic polymer such as PEBAX (Polyether BlockAmide), but could also be made from other elastic and resilientmaterials.

The lever 22 in FIG. 2 is shown in the lowermost position which may beconsidered as the “at rest” position. This is also substantially thesame position illustrated in FIGS. 7 and 12. This would be achieved byeither action of the return spring 82 in the bore 80 of the slider 28 incertain instruments or by the surgeon manually moving the lever to thatposition in other embodiments of the instrument where a return spring isnot used.

FIGS. 2 and 3 illustrate the lever 22 passing through a slot 73 in thehandle and being mounted to a pivot pin 72. An arm 70 of the lever 22has a cylindrical head 71 which mates with a recess 74 in a boss 75 atthe proximal end of the slider 28. The slider 28 sits in the slideway 84and moves proximally and distally in response to the lever positionand/or return spring action. The slider 28 carries the rotatable barrel66 clamped to the push/pull cable 38 by means of the set screws 67 orthe like. The barrel 66 is rotatable in response to the rotation of theinstrument shaft and end effector. Refer also to FIG. 7 for furtherdetails of the slider mechanism. The barrel 66 sits in a slot 68 whichis open to a contiguous slot 78 at one end and is closed by a wall 69 atits other end. The wall 69 has a through hole which acts as a guide forthe push/pull cable 38 that protrudes from the proximal end of thebarrel 66, and thus guides the barrel action itself. The barrel 66 isurged against the wall by a compression spring 76 that is disposed inthe slot 78. The position of the lever, as depicted in FIG. 2 has thejaws fully open as also shown in FIG. 4A. Refer to co-pending Ser. No.11/528,134 filed on Sep. 27, 2006 for further details of the operationof the lever and slider.

The jaw clamping lever 22 is also adjustable for left and right handedoperation as well as a range of adjustment from angle C in FIG. 5 toangle D in FIG. 6. This is accomplished by means of a cam lever 240 atthe base of the handle that rotates approx. 180 degrees about shaft 72that also supports jaw clamping lever 22. The control by the lever 240may also be by rotation through other angles. The cam lever 240basically adjusts the attitude of the clamping lever 22 relative to acenter line or center plane of the handle as represented by the line orplane W in FIGS. 5 and 6 which illustrate the opposite directionattitudes depending on the position of the lever 240. This adjustmentcan be made based on whether the user is right handed or left handed, orcan be made on the basis of some other characteristic of the hand of theuser such as finger length.

The cam lever 240 includes a wedge shaped washer 242 with a truncatedball 244 formed on the inside sloped surface of the washer portion. Theball and washer have a through hole 246 that fits over shaft 72 andallows the lever to pivot about the shaft 72 upwardly or downwardly froma front to rear position relative to the base of the handle as seen inFIGS. 5 and 6. The ball 244 has mating features shown at 248 in FIG. 6and preferably in the form of two slots that mate with two lugs on a camdisk 250. These mating features synchronize rotation of the lever 240and cam disk 250. Cam disk 250 is also basically a wedge shaped washerwith a through hole 252 that allows it to pivot on shaft 72 in responseto the rotation of cam lever 240. Cam disk 250 is illustrated in FIG.

6 as having two detents 254 on its outer face that interact with twobumps (not shown) on the side of slot 73 to preferably hold it in eitherof the two positions shown in FIGS. 5 and 6. The ball 244 sits in thebore 256 of lever 22 and allows lever 22 to change angle in response torotation of the cam lever 240 and the relative positions of the angledfaces of disks 242 and 250.

The jaw clamping means 30 uses a ratcheting and release mechanisms andis shown in a series of positions in FIGS. 12-14. The ratchetingmechanism is illustrated by the leaf spring 92 with an angled end 94that engages teeth 86 on the slider 28 as lever 22 is squeezed. FIG. 12shows the mechanism in an initial position, such as the position shownin FIG. 2 corresponding to an open position of the jaws. FIG. 13 showsthe clamping lever at an advanced position with the end 94 of the spring92 engaging one of the teeth 86 on the slider 28. For release of thejaws, the lever 22 is squeezed all the way to the position of FIG. 14 atwhich point, wall 69 contacts latch 96 and rotates latch 96counterclockwise around pivot 90 until spring 92 is lifted out ofengagement with the teeth 86 by the latch face 96B engaging theunderside of the spring 92. FIG. 14 shows the leaf spring 92 beinglifted so as to disengage from the ratchet teeth 86. This action leavesthe slider 28 free to move to the left as seen in FIG. 14 until wall 79contacts and rotates the latch 96 clockwise around pivot 90 until face96A is aligned with the underside of the spring, allowing it to dropinto place for engagement with the end of the slider 28 just to the rearof the teeth 86, as in the position illustrated in FIG. 12.

The spring 92 and the teeth 86 form a ratchet arrangement in which thelever 22 may be clicked through a number of positions in closing the endeffector and tightening the jaws of the end effector about an item suchas a needle. As the lever 22 is depressed inwardly toward the handle,then the free end 94 of the latch spring 92 engages with various teethon the slider. The jaws are tightened by each successive click until theitem being grasped is fully engaged. In order to release the actuationsequence, rather than using a separate release button, the lever 22 issimply moved to its most inward position such as illustrated in FIG. 14where the latch 96 engages the wall 79. This pivots the latch to aposition where it lifts the spring 92 thus disengaging the spring fromthe teeth on the slider and enabling the slider to thus move underspring bias to its released position.

The locking mechanism or angle locking means 140 of the presentinvention includes a ball and socket arrangement that is basicallydisposed over the proximal bendable member and that follows the bendingat the proximal bendable member. The locking mechanism has locked andunlocked positions, is disposed about the proximal movable or bendablemember and is manually controlled so as to fix the position of theproximal movable member relative to the handle in the locked positionthereof. The locking mechanism comprises a ball member and acompressible hub that defines a socket member. In the disclosedembodiment the hub is a split hub and the locking mechanism furtherincludes a cinch ring disposed about the split hub and a locking levermounted on the cinch ring for closing the cinch ring about the hub tolock the hub against the spherical ball member. The cinch ringinterlocks with the hub but is able to rotate relative thereto when inthe unlocked position.

The “ball” part is basically formed by the ball member 120, while the“socket” part is basically formed by an extension of the handle, namelythe split hub 202. The locking mechanism locks the proximal bendablemember in a desired position and by doing that also locks the positionof the distal bendable member and tool. The proximal bending member 18,although it is enclosed the ball and socket arrangement, still allowsthe instrument shaft 14 and the proximal bending member 18, along withthe cabling 100, to rotate freely while also allowing the axis of theinstrument shaft to be angled relative to the axis of the handle in afree, or alternately, locked mode.

For this purpose refer to the ball member 120 which is shown in furtherdetail in FIGS. 5-8. The ball member 120 includes a distal neck 206 thatis contiguous with a partially spherical ball end having a sphericalouter surface 204. The neck 206 is basically disposed over the adaptor26 and conical portion 19 of the proximal bendable member 18, while theball portion is mainly disposed over the primary part of the proximalbendable member 18. The ball member 120 is adapted to sit within asocket that is formed in the handle in the form of a hub 202 that can becollapsed about the ball member 120 by radially compressing the cinchring 200.

The ball member 120 is gimbaled in a split hub 202 that is comprised offour quadrants 202A-202D that can be clamped against the sphericalsurface 204 of the ball member 120 by means of the cinch ring 200. Referto FIG. 8. The split hub 202 is supported at the distal end of thehandle by means of three struts 230 that are spaced approximately 120degrees apart (see FIG. 11). The ball member 120 has a neck portion 206that provides support for the distal end of the proximal bendable member18. In this regard a bearing surface 208 is provided, as illustrated inFIGS. 7 and 8, between the proximal end of the neck 206 and the adaptor26. This enables the proximal bendable member, along with the adaptor 26to be free to rotate relative to the ball member 120. FIGS. 7 and 8 alsoillustrate a bearing surface at 210 between the very distal end of theneck 206 and the outer tube 32. These bearing surfaces 208, 210 may beformed by actual bearings at those locations.

FIGS. 5-8 illustrate the cinch ring 200. Refer also to FIGS. 2 and 3 foran illustration of the cinch ring 200. The cinch ring 200 is an annularmember that has an internal ridge or spline 201 that is adapted to matewith a channel or groove 203 in the outer surface of the split hub 202.This combination of a channel and ridge limits the annular cinch memberto just rotation about the hub 202. FIG. 8 also shows that each of theportions 200A-200B of the split hub connects to the instrument handlevia respective struts 230 (see also FIG. 11). When the cinch ring 200 isclosed this, in turn, closes the slotted hub and essentially compressesthe socket (hub 202) against the spherical surface 204 of the ballmember 120. The locking of the ball member thus fixes the position ofthe proximal bendable member, and, in turn, the distal bendable memberand tool.

The cinch ring 200 is operated by means of an over-center locking lever220 that is connected to ends 200A and 200B of the cinch ring 200 bymeans of the pins 222 and 224, respectively. FIG. 5 illustrates the locklever 220 in a locked position while FIG. 6 illustrates the lock leverin a released or unlocked position. The end 200A of the cinch ring 200is in the form of a detachable hook that snap fits over pin 222 and sitsin a slot 226 of the lever 220 when the ring is locked. The other end200B of the cinch ring 200 is in the form of two bales that snap fitover pin 224 formed on the sides of the lever 220. The cinch ring 200 isfree to rotate around the split hub 202 when lever 220 is released bymeans of the spline 201 that rides in the groove 203 in thecircumference of the split hub 202. This allows for left or right handedoperation of the instrument. FIG. 5 illustrates a set up for a righthanded operation with the angle locking lever 220 shown in a lockedposition and FIG. 6 illustrates a set up for a left handed operation,with the angle locking lever 220 shown in an unlocked position.

When the locking lever 220 is moved to its locked position thiscompresses the cinch ring 200 closing the hub against the sphericalouter surface 204 of the ball member 120. This locks the handle againstthe ball member 120 holding the ball member in whatever position it isin when the locking occurs. By holding the ball member in a fixedposition this, likewise, holds the proximal bendable member in aparticular position and fixed in that position. This, in turn, maintainsthe distal bendable member and tool at a fixed position, but theinstrument orientation can be controlled via the control of the rotationknob which controls the orientation of the instrument tip by enablingrotation of the distal bendable member and tool about the tip axis P(see FIG. 3).

The instrument of the present invention provides an improved instrument,particularly from the standpoint of ease of use by the surgeon. The toolactuation lever arrangement permits fine control by the user,particularly with the instrument arrangement that has the recessedgimbal where the finger of the user can be readily engaged with thelever. This arrangement also enables the instrument to be readilyadapted for either right-handed or left-handed control by simplyrotating the gimbal in its socket between opposite positions. It is alsopreferred that the recess in the gimbal be formed by a blind hole (witha bottom wall) as this has been found to provide enhanced manual controlof the lever positioning.

Another improvement of the instrument of the present invention relatesto the ease with which the tool can be controlled including theconvenient placement of the rotation member and the convenient placementof the locking arrangement where the users thumb and forefinger can bereadily used to control both tip rotation as well as locking Thesefunctions can be performed with a single hand and without requiring theuser to move the hand position.

Having now described a limited number of embodiments of the presentinvention it should now be apparent to one skilled in the art thatnumerous other embodiments and modifications are contemplated as fallingwithin the scope of the present invention as defined by the appendedclaims. For example, in another version of the present invention adifferent form of instrument tip rotation means may be used such as aslide mechanism to control distal rotation about the tool tip axis. Evenwith such alternate means a locking function may still be associatedwith the instrument to provide the lock function. The locking meansdescribed herein has been illustrated for use with a pistol grip handle,however, this locking means may also be provided on an in-lineinstrument such as the type illustrated in Ser. No. 11/185,911 filed onJul. 20, 2005. Also, in the instrument that is described herein themovable members have been illustrated as bendable sections, and moreparticularly, as unitary bendable sections. However, the movable membersmay alternatively be of other constructions including, but not limitedto, engageable discs, bellows arrangements, a movable ring assembly orball and socket members. For other forms of bendable members refer toco-pending provisional applications Ser. No. 60/802,885 filed on May 23,2006 and 60/811,046 filed on Jun. 5, 2006, both of which are herebyincorporated by reference herein in their entirety. Also, in theinstrument that is described herein the ball and socket arrangement hasthe ball part on a separate member that mates with a socket associatedwith the handle. In still another embodiment of the present inventionthe ball and socket arrangement may comprise a separate socket memberthat mates with a protruding ball of the handle.

1. A surgical instrument comprising: an instrument shaft having proximaland distal ends; a tool disposed from the distal end of the instrumentshaft; a control handle coupled from the proximal end of the instrumentshaft; a distal motion member for coupling the distal end of saidinstrument shaft to said tool; a proximal motion member for coupling theproximal end of said instrument shaft to said handle; actuation meansextending between said distal and proximal motion members for couplingmotion of said proximal motion member to said distal motion member forcontrolling the positioning of said tool; and a locking mechanism forfixing the position of the tool at a selected position and having lockedand unlocked states; said locking mechanism including a ball and socketarrangement disposed about said proximal motion member and a cinchmember for locking said ball and socket arrangement.
 2. The surgicalinstrument of claim 1 further including a rotation means disposedadjacent the control handle and rotatable relative to the control handlefor causing a corresponding rotation of the instrument shaft and tool.3. The surgical instrument of claim 2 wherein at least said proximalmotion member comprises a proximal bendable member, said rotation meanscomprises a rotation knob that is adapted to rotate the tool about adistal tool roll axis and said rotation knob is disposed between saidcontrol handle and proximal bendable member.
 4. The surgical instrumentof claim 1 wherein said control handle comprises a pistol grip handlehaving an engagement horn to assist in holding the handle.
 5. Thesurgical instrument of claim 4 wherein said rotation means comprises arotation knob that is disposed at the distal end of the handle and saidhorn is disposed proximally of the rotation knob and on the top of thepistol grip handle.
 6. The surgical instrument of claim 4 including anactuation lever supported from said pistol grip handle at a pivot pointat the proximal end of the handle.
 7. The surgical instrument of claim 6wherein said actuation lever has a free end with a finger loop forreceiving a users finger to control the lever.
 8. The surgicalinstrument of claim 1 including a tool actuation cable that extends fromsaid tool to said handle, a slider for capturing the proximal end ofsaid tool actuation cable and an actuation lever supported at saidhandle for controlling the translation of said slider.
 9. The surgicalinstrument of claim 8 including a slideway for receiving said slider, apair of springs disposed in said slider and a rotational barrel disposedbetween said springs and for holding the proximal end of said toolactuation cable.
 10. The surgical instrument of claim 1 wherein the balland socket arrangement comprises a ball member having a partiallyspherical portion that mates with a concave socket in the handle. 11.The surgical instrument of claim 10 wherein said handle has a distalcollar with the socket formed on the inner surface of the collar andsaid cinch member includes an annular cinch ring that is disposed aboutsaid distal collar.
 12. The surgical instrument of claim 11 including atongue and groove interconnection between said cinch ring and collar soas to permit rotation therebetween while preventing axial movement. 13.The surgical instrument of claim 12 including a pivot piece on saidcinch ring having opposed locked and unlocked positions.
 14. Thesurgical instrument of claim 11 wherein said distal collar has one ormore slot to enable the socket to be compressed about the ball member asthe cinch ring is locked.
 15. A surgical instrument comprising; aninstrument shaft having proximal and distal ends; a tool disposed fromthe distal end of the instrument shaft; a control handle disposed fromthe proximal end of the instrument shaft; a distal motion member forcoupling the distal end of said instrument shaft to said tool; aproximal motion member for coupling the proximal end of said instrumentshaft to said handle; actuation means extending between said distal andproximal motion members for coupling motion of said proximal motionmember to said distal motion member for controlling the positioning ofsaid tool; said control handle including a pistol grip handle; anactuation lever for controlling said tool and pivotally supported fromsaid handle; and an adjustment member mounted on said lever foradjusting the attitude of the actuation lever relative to a center planeof the handle.
 16. The surgical instrument of claim 15 wherein saidadjustment member includes an adjustment lever for changing the attitudebetween positive and negative values.
 17. The surgical instrument ofclaim 16 wherein said adjustment member includes a beveled washer means.18. The surgical instrument of claim 16 wherein said adjustment lever issupported from the same pivotal support as for the actuation lever. 19.The surgical instrument of claim 15 further including an engagement hornto assist in holding the handle and a rotation knob disposed at thedistal end of the handle and said horn is disposed proximally of therotation knob and on the top of the pistol grip handle.
 20. In a medicalinstrument having a proximal control handle and a distal tool that areintercoupled by an elongated instrument shaft that is meant to passinternally of an anatomic body, proximal and distal movable members thatrespectively intercouple said proximal control handle and said distaltool with said instrument shaft, cable actuation means disposed betweensaid movable members, said control handle having proximal and distalends, an actuation lever for controlling said distal tool, means forpivotally supporting said actuation lever from the proximal end of saidhandle at one side thereof, a horn and means for fixedly supporting saidhorn from the distal end of said handle at an opposite side thereof.21-31. (canceled)